Provider Demographics
NPI:1215633516
Name:MCCALL, EBONY DARCEL
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:DARCEL
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 OAK FOREST DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1607
Mailing Address - Country:US
Mailing Address - Phone:704-761-3207
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-390-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health